Summary

A joint dislocation is when the bones that form a joint are forced out of their normal position, so the joint surfaces are no longer in contact. Think of a joint as two bones fitting together like puzzle pieces—when a joint dislocates, the bones are pulled apart, causing severe pain, deformity, and loss of function. Dislocations can be complete (bones completely separated) or partial (subluxation—bones partially separated). They usually occur from trauma (high force applied to the joint), but some joints are more prone to dislocation due to laxity or previous injury. The most common dislocations are shoulder, finger, elbow, and patella (kneecap). The key to management is recognizing the dislocation (obvious deformity, severe pain, loss of function), assessing for complications (nerve injury, vascular injury), reducing the dislocation promptly (putting the bones back in place—usually under sedation or anesthesia), immobilizing after reduction, and monitoring for complications. Most dislocations can be reduced successfully, but some need surgery if they can't be reduced or if there are complications.

Key Facts

• Definition: Bones of a joint forced out of normal position
• Incidence: Common (thousands of cases/year)
• Mortality: Very low (<0.1%) unless complications
• Peak age: All ages, but more common in young adults (trauma)
• Critical feature: Obvious deformity, severe pain, loss of function
• Key investigation: Clinical diagnosis (usually obvious), X-ray before and after reduction
• First-line treatment: Reduction (put bones back), immobilization, assess for complications

Clinical Pearls

"Deformity is usually obvious" — Joint dislocations usually cause obvious deformity. The joint looks wrong, and the patient can't move it. This is usually obvious on examination.

"Check neurovascular status before and after reduction" — Always check pulses, sensation, and movement before and after reducing a dislocation. Neurovascular injury can occur with dislocations.

"Reduce promptly" — Dislocations should be reduced as soon as possible (usually within hours). Delayed reduction is harder and increases the risk of complications.

"X-ray before and after" — X-ray before reduction to confirm and check for fractures. X-ray after reduction to confirm reduction and check for fractures that occurred during reduction.

Why This Matters Clinically

Joint dislocations are common injuries that can cause significant pain and functional loss. Early recognition, prompt reduction, and assessment for complications (especially neurovascular injury) are essential. This is a condition that emergency and orthopedic clinicians manage frequently, and prompt treatment leads to excellent outcomes.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: Usually normal
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal (check for vascular injury)
• Feel: Pulse (check distal pulses), BP (usually normal)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Check neurovascular status

D - Disability

• Assessment: Usually normal (check for nerve injury)
• Action: Assess if nerve injury

E - Exposure

• Look: Joint examination
• Feel: Deformity, check neurovascular
• Action: Complete examination

Specific Examination Findings

Joint Examination:

• Inspection: Obvious deformity
• Palpation:
  • Deformity: Obvious
  • Tenderness: Severe tenderness
  • Gap: May feel gap where joint should be
• Function: Can't move joint
• Neurovascular: Check before and after reduction

Site-Specific Findings:

Special Tests

Natural History (Without Treatment)

Untreated Dislocation:

• Persistent deformity: Joint stays dislocated
• Functional loss: Can't use joint
• Complications: Risk of nerve/vascular injury
• Poor outcomes: If not treated

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early reduction: Better outcomes
• No complications: Better outcomes
• First dislocation: Better outcomes
• Good rehabilitation: Better outcomes

Poor Prognosis:

• Delayed reduction: Worse outcomes
• Complications: Nerve/vascular injury worsen outcomes
• Recurrent dislocations: May need surgery
• Poor rehabilitation: Worse outcomes

Prognostic Factors

Key Guidelines

1. BOA Guidelines (2015) — Management of joint dislocations. British Orthopaedic Association

Key Recommendations:

• Prompt reduction
• Neurovascular assessment
• Immobilization
• Evidence Level: 1A

Landmark Trials

Multiple studies on reduction techniques, outcomes.

Evidence Strength

What is a Joint Dislocation?

A joint dislocation is when the bones that form a joint are forced out of their normal position, so they're no longer fitting together properly. Think of a joint as two bones fitting together like puzzle pieces—when a joint dislocates, the bones are pulled apart, causing severe pain, obvious deformity, and loss of function.

In simple terms: Your joint has "popped out" of place. This is serious and painful, but with prompt treatment (putting the bones back in place), most people recover well.

Why does it matter?

Joint dislocations cause severe pain and loss of function and need prompt treatment. Early recognition and prompt reduction (putting the bones back in place) are essential. The good news? Most dislocations can be reduced successfully, and most people recover well.

Think of it like this: It's like a joint "popping out" of place—it needs to be put back, but once it's back, most people recover well.

How is it treated?

1. Assessment:

• Examination: Your doctor will examine the joint and check for complications (nerve or blood vessel injury)
• X-ray: You'll have an X-ray to confirm the dislocation and check for fractures
• Why: To see how serious it is and plan treatment

2. Reduction (Putting Bones Back):

• What: Your doctor will put the bones back in place (you'll get pain relief/sedation)
• When: Usually as soon as possible (within hours)
• Why: To restore function and prevent complications
• How: Specific technique for each joint

3. After Reduction:

• X-ray: Another X-ray to confirm it's back in place
• Neurovascular check: Your doctor will check again for nerve or blood vessel injury
• Immobilization: You'll wear a splint or sling to protect the joint while it heals

4. Rehabilitation:

• Physical therapy: You'll do exercises to regain strength and movement
• Gradual return: You'll gradually return to activities
• Why: To help you recover and prevent it happening again

The goal: Put the bones back in place, protect the joint while it heals, and help you regain full function.

What to expect

Recovery:

• Reduction: Usually done within hours
• Immobilization: You'll wear a splint or sling for 2-6 weeks (varies by joint)
• Healing: The joint usually heals within 6-12 weeks
• Full recovery: Most people are back to normal within 3-6 months

After Treatment:

• Pain: Should improve quickly after reduction
• Immobilization: You'll need to protect the joint while it heals
• Physical therapy: You'll do exercises to regain strength
• Follow-up: Regular follow-up to monitor healing

Recovery Time:

• Reduction: Usually within hours
• Healing: Usually 6-12 weeks
• Full recovery: Usually 3-6 months

When to seek help

Call 999 (or your emergency number) immediately if:

• You have an obvious joint deformity and severe pain
• You can't move a joint after an injury
• You have numbness or weakness in the affected limb
• Your limb is pale, cold, or pulseless
• You feel very unwell

See your doctor if:

• You have joint pain and deformity after an injury
• You have concerns about a joint injury
• You have a joint that keeps dislocating

Remember: If you have an obvious joint deformity and severe pain after an injury, especially if you can't move the joint or have numbness or weakness, call 999 immediately. Joint dislocations are serious but usually easily treated by putting the bones back in place. Don't try to put it back yourself—let a doctor do it.